Starting antiretroviral treatment early gives patients a head start

Professor Robin Wood

The unit has been a major participant in an important international randomised clinical trial, and has found that individuals who begin antiretroviral treatment at a CD4 count over 500/mm3 experience substantial health benefits over those who start treatment at a CD4 count of 350/mm3.

The Strategic Timing of AntiRetroviral Treatment (START) study tested whether there was benefit to HIV+ patients in initiating antiretroviral treatment early. More than 4,600 men and women living with HIV were enrolled at 215 sites in 35 countries.

The trial was scheduled to close in December 2016 but a review by the study's Independent Data and Safety Monitoring Board recommended that results be released early as the evidence was overwhelmingly in favour of early initiation of antiretroviral therapy.

The study took place over three years and found that patients on the study had low levels of serious illness but those that were initiated earlier had a clear further benefit compared to those starting late. The rates of adverse events were similar in both groups indicating antiretroviral therapy was safe

"This is a very encouraging result that will inform policy, based on good quality data," said Prof. Robin Wood, M.D., of the Desmond Tutu HIV Centre, University of Cape Town and site Principal Investigator for the study in Cape Town. "We now have strong evidence that early treatment is beneficial to the HIV-positive person."

In the light of these findings, all our participants are being informed of these results. They will be offered treatment if they are not already on antiretroviral therapy, and they will continue to be followed until the end of 2016.